Intraocular Pressure Elevation during Lateral Body Posture in Side-sleeping Glaucoma Patients

Abstract

SIGNIFICANCE In side-sleeping open-angle glaucoma (OAG) patients, eyes that showed progression exhibited a greater intraocular pressure (IOP) elevation when subjects were rested in the lateral decubitus (LD) posture on the ipsilateral side compared with those eyes that did not progress. PURPOSE The purposes of this study were to investigate whether lying in the LD position for an extended period affects IOP in side-sleeping patients with OAG when rested on their own pillow and to compare posture-induced IOP variations between eyes with recent glaucomatous progression and those without. METHODS Twenty-eight bilateral OAG patients who reported a preference for side sleeping were included. We measured IOP in both eyes, with the patient in the sitting and supine positions, 5 and 30 minutes after they had been in the right or left LD position (depending on their sleeping habits) and 5 minutes after they had returned to the supine position. While in the recumbent postures, the patients rested on their own pillows from home. The patients were divided into the correspondence and noncorrespondence subgroups, based on whether the laterality of the progressed eye corresponded with their habitual sleeping side. RESULTS The IOP of the lower-sided eye increased further (+1.6 ± 1.8 mmHg; P < .001) when the LD posture was maintained for an additional 25 minutes. Such time-dependent IOP elevation in the dependent eye was greater in patients whose LD posture corresponded with glaucoma progression (+2.5 ± 1.7 mmHg) than in those who showed no correspondence or no glaucoma progression (+1.0 ± 1.6 mmHg; P = .03). CONCLUSIONS Compared with nonprogressed eyes, progressed eyes exhibited a greater IOP elevation when the side-sleeping patients with OAG were rested in the LD posture on the ipsilateral side.

Interaction of intraocular pressure and ganglion cell function in open angle glaucoma

“…This is in accordance with previous studies, that demonstrated LDP induced IOP increase of the lower eye in comparison to either sitting and/or supine postures in either healthy subjects 10,11,40 or untreated glaucoma patients 14,41 . The GLAIMP-group showed higher IOP fluctuations and rise than healthy subjects during postural change from sitting to LDP, which is in line with other studies that reported that higher LDP-or supineinduced IOP changes were associated with more progression or asymmetrical visual field defects of untreated and treated glaucoma patients 13,14,[42][43][44][45] ; however, others did not report a relationship of LDP-induced changes and glaucoma progression or laterality 15,46 . Our GLALE-group showed no significant IOP change during LDP vs sitting.…”

Non-invasive electrophysiology in glaucoma, structure and function—a review

“…Continuous IOP measurement allows for the investigation of short-term fluctuations of IOP and its direct effect on RGC function during simultaneous PERG recordings: the robustness of steady-state PERG allowed simultaneous recording with the continuous IOP measurement due to its frequency-based amplitude extraction at 15 Hz that is dissociated from the sensor frequency intrusions at 9 Hz [ 59 ]. The LDP induced a significantly higher IOP in the lower eyes in accordance with other studies [ 61 , 62 ], in both glaucoma patients with the eyemate-IO sensor and healthy controls. The increased IOP was accompanied by reversible reductions of RGC responses determined via PERG both in controls and glaucomatous eyes.…”

Posture-induced Changes in Intraocular Pressure After Trabeculectomy in Patients With Primary Open-angle Glaucoma

“…The iCare has been designed to hold the probe to prevent dropping. To measure the IOP in the supine position and LDP, a soft pillow was placed under the head to maintain it parallel to the bed as has been previously described 5,7,11,19,20. For each position, 3 consecutive sets of measurements were taken (6 measurements for each set).…”

“…To measure the IOP in the supine position and LDP, a soft pillow was placed under the head to maintain it parallel to the bed as has been previously described. 5,7,11,19,20 For each position, 3 consecutive sets of measurements were taken (6 measurements for each set). The average values of each set were calculated automatically, and the mean values obtained for 3 consecutive sets of measurements in each position were used for the statistical analyses.…”